Deep brain stimulator complications: Difference between revisions
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==Background== | ==Background== | ||
* | [[File:Deep brain.jpg|thumb]] | ||
*FDA-approved for medication-refractory movement disorders (e.g. [[Parkinson's disease]], dystonia, essential tremor) and OCD | |||
**Being studied for use in [[epilepsy]], chronic pain, depression, PTSD | |||
*Single lead systems implanted into the thalamus | *Single lead systems implanted into the thalamus | ||
*Complication rates range from 7-65%<ref>Tabbal SD, Revilla FJ, Mink JW, et al. Safety and efficacy of subthalamic nucleus deep brain stimulation performed with limited intraoperative mapping for treatment of Parkinson's disease. Neurosurgery. 2007;61(3 Suppl):119-27.</ref> | |||
==Clinical Features== | ==Clinical Features/Complication Types== | ||
*Infection | |||
**Usually early after placement | |||
**Infection rates ~3-10%<ref>Tabbal SD, Revilla FJ, Mink JW, et al. Safety and efficacy of subthalamic nucleus deep brain stimulation performed with limited intraoperative mapping for treatment of Parkinson's disease. Neurosurgery. 2007;61(3 Suppl):119-27.</ref> | |||
*Cerebral hemorrhage | |||
*Lead fracture or migration | |||
*Failure of device to improve tremor/motor symptoms | |||
*Paresthesias (temporary or permanent) | |||
*Dysarthria, decreased verbal fluency | |||
*Disequilibrium | |||
*Affective changes (depression, apathy), impaired executive function, impulsivity | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
==Evaluation== | ==Evaluation== | ||
*May need to observe with device in "off" position to distinguish between device malfunction and other acute neurologic deficit | |||
==Management== | ==Management== | ||
*Consult neurosurgery | |||
==Disposition== | ==Disposition== | ||
Revision as of 20:38, 9 November 2016
Background
- FDA-approved for medication-refractory movement disorders (e.g. Parkinson's disease, dystonia, essential tremor) and OCD
- Being studied for use in epilepsy, chronic pain, depression, PTSD
- Single lead systems implanted into the thalamus
- Complication rates range from 7-65%[1]
Clinical Features/Complication Types
- Infection
- Usually early after placement
- Infection rates ~3-10%[2]
- Cerebral hemorrhage
- Lead fracture or migration
- Failure of device to improve tremor/motor symptoms
- Paresthesias (temporary or permanent)
- Dysarthria, decreased verbal fluency
- Disequilibrium
- Affective changes (depression, apathy), impaired executive function, impulsivity
Differential Diagnosis
Evaluation
- May need to observe with device in "off" position to distinguish between device malfunction and other acute neurologic deficit
Management
- Consult neurosurgery
Disposition
See Also
External Links
References
- ↑ Tabbal SD, Revilla FJ, Mink JW, et al. Safety and efficacy of subthalamic nucleus deep brain stimulation performed with limited intraoperative mapping for treatment of Parkinson's disease. Neurosurgery. 2007;61(3 Suppl):119-27.
- ↑ Tabbal SD, Revilla FJ, Mink JW, et al. Safety and efficacy of subthalamic nucleus deep brain stimulation performed with limited intraoperative mapping for treatment of Parkinson's disease. Neurosurgery. 2007;61(3 Suppl):119-27.